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Malignant Adrenal Neoplasm Masquerading as Worrisome Adrenal Hemorrhage

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adrenal hemorrhage (AH) associated with adrenal neoplasm is rare. This study assesses the clinical and pathological impact of AH in the setting of malignant adrenal neoplasm to establish management strategies.

Materials and Methods

Patients admitted over a 25-year period with a diagnosis of AH and malignant adrenal neoplasm were retrospectively reviewed.

Results

Malignant adrenal neoplasms were reported in 14 of 217 patients (6.4%) presenting with AH. Of these, 4 were women. Mean age was 56 years. The most common presenting symptom was abdominal pain (n = 6), followed by altered mental status and shock (2) and hypercortisolism (1). Five patients were asymptomatic. In 10 patients the adrenal tumor was metastatic. Four patients had adrenocortical carcinoma (ACC). All primary adrenal tumors were unilateral. Risk factors for AH were identified in 5 patients (anticoagulation, 3; trauma, 1; and recent surgery, 1). Computed tomography (n = 12) demonstrated adrenal masses ranging in size from 6.8 to 11.0 cm (mean, 9 cm). Nine patients were managed by surgical resection (adrenalectomy, 4; radical nephrectomy, 2; adrenalectomy/splenectomy, 1; adrenalectomy/bowel resection, 1; and laparotomy and packing, 1) Actual survival time ranged from 9 days to 7.8 years (median 329 days).

Conclusion

Most patients with AH in the setting of malignant adrenal neoplasm had metastatic tumors to the adrenal glands. These patients do not typically present in hemorrhagic shock, allowing for adequate preoperative evaluation for function and assessment for primary tumors. Long-term survival of these patients is rare.

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References

  1. Xarli VP, Steele AA, Davis PJ, Buescher Es, Rios CN, Garcia-Bunuel R. Adrenal hemorrhage in the adult. Medicine (Baltimore). 1978;57:211–21.

    CAS  Google Scholar 

  2. Vella A, Nippoldt TB Morris JC. Adrenal hemorrhage: a 25 year experience at the Mayo Clinic. Mayo Clin Proc. 2001;76:161–8.

    Article  CAS  PubMed  Google Scholar 

  3. Rodriguez Martinez JJ, Herreros Villaraiz M, Perez Garcia FJ, Fernandez Gomez JM, Martinez Gomez J, Regadera Sejas J, et al. Suprarenal hemorrhage as the first manifestation of a small cell pulmonary carcinoma. Presentation of a case. Arch Esp Urol. 2000;53:726–30.

    CAS  PubMed  Google Scholar 

  4. Outwater E, Bankoff MS. Clinically significant adrenal hemorrhage secondary to metastases. Computed tomography observations. Clin Imaging. 1989;13:195–200.

    Article  CAS  PubMed  Google Scholar 

  5. Tanaka K, Noguchi S, Shuin T, Kinoshita Y, Kubota Y, Hosaka M. Spontaneous rupture of adrenal pheochromocytoma: a case report. J Urol. 1994;151:120–1.

    CAS  PubMed  Google Scholar 

  6. Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage, early recognition and treatment. Ann Intern Med. 1989;110:227–35.

    CAS  PubMed  Google Scholar 

  7. Thompson KE, Willard BT, Kuvshinoff, Teague JL. Adrenal hemorrhage mimicking an abdominal aortic aneurysm. Urology. 2003;61:1260xviii–1260xix.

  8. Chen R. Adrenal crisis. Crit Care Clin. 1991;7:23–42.

    Google Scholar 

  9. Black RM, Daniels GH, Coggins CH, Mueller PR, Data RE, Lichtenstein N. Adrenal insufficiency from metastatic colonic carcinoma masquerading as isolated aldosterone deficiency. Report of a case and review of literature. Acta Endocrinol. 1981;98:586–91.

    CAS  PubMed  Google Scholar 

  10. Lam KY, Lo CY. Metastatic tumors of the adrenal glands: a 30 year experience in a teaching hospital. Clin Endocrinol. 2002;56:95–101.

    Article  Google Scholar 

  11. Karanikiotis C, Tentes AA, Markakidis S, Vafiadis K. Large bilateral adrenal metastases in non-small cell lung cancer. World J Surg Oncol. 2004;2:37.

    Article  PubMed  Google Scholar 

  12. Landen S, Delugeau V. Adrenal hemorrhage mimicking an acute abdomen. Am J Emerg Med. 2005;23:219–20.

    Article  PubMed  Google Scholar 

  13. Xiao XR, Ye LY, Shi LX, Cheng GF, Li YT Zhou BM. Diagnosis and treatment of adrenal tumours: a review of 35 years’ experience. Br J Urol. 1998;82:199–205.

    CAS  PubMed  Google Scholar 

  14. Lockhart ME, Smith JK, Kenney PJ. Imaging of adrenal masses. Eur J Radiol. 2002;41:95–112.

    Article  PubMed  Google Scholar 

  15. Dunnick NR, Heaston D, Halvorsen R, Moore AV, Korobkin M. CT appearance of adrenal cortical carcinoma. J Comput Assist Tomogr. 1982;6:978–82.

    Article  CAS  PubMed  Google Scholar 

  16. Harrison LE, Gaudin PB, Brennan MF. Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Arch Surg. 1999;134:181–5.

    Article  CAS  PubMed  Google Scholar 

  17. Oo TH, Martin L, Hesketh PJ. Adrenal hemorrhage secondary to metastasis from lung cancer. Clin Lung Cancer. 2002;4:183–5.

    Article  PubMed  Google Scholar 

  18. Brunt LM, Moley JF, Adrenal incidentaloma. World J Surg. 2001;25:905–13.

    Article  CAS  PubMed  Google Scholar 

  19. Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer. 1998;82:389–94.

    Article  CAS  PubMed  Google Scholar 

  20. Kendrick ML, Lloyd R, Erickson L, Farley DR, Grant CS, Thompson GB, et al. Adrenocortical carcinoma surgical progress or status quo? Arch Surg. 2001;136:543–9.

    Article  CAS  PubMed  Google Scholar 

  21. Lenert JT, Barnett CC, Kudella AP, Sellin RV, Gagel RF, Prieto VG, et al.; Evaluation and surgical resection of adrenal masses in patients with extra-adrenal malignancy. Surgery. 2001;130:1060–7.

    Article  CAS  PubMed  Google Scholar 

  22. Kobayashi T, Iwai A, Takahashi R, Ide Y, Nishizawa K, Mitsumori K, et al. Spontaneous rupture of adrenal pheochromocytoma: review and analysis of prognostic factors. J Surg Oncol. 2005;90:31–5.

    Article  PubMed  Google Scholar 

  23. Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional experience. Surgery. 1991;110:1014.

    CAS  PubMed  Google Scholar 

  24. Mercier O, Fadel E, de Perrot M, Mussot S, Stella F, Chapelier A, et al. Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005;130:136–40.

    Article  PubMed  Google Scholar 

  25. Moudouni SM, En-nia I, Manunta A, Guille F, Lobel B. Factors influencing adrenal metastasis in renal cell carcinoma. Int Urol Nephrol. 2003;35:141–7.

    Article  CAS  PubMed  Google Scholar 

  26. Murakami S, Terakado M, Hashimoto T, Tsuji Y, Okubo K, Hirayama R. Adrenal metastasis from rectal cancer: report of a case. Surg Today. 2003;33:126–30.

    Article  PubMed  Google Scholar 

  27. Haigh PI, Essner R, Wardlaw JC, Stern SL, Morton DL. Long-term survival after complete resection of melanoma metastatic to the adrenal gland. Ann Surg Oncol. 1999;6:633–9.

    Article  CAS  PubMed  Google Scholar 

  28. Knight B. Sudden unexpected death from adrenal hemorrhage. Forensic Sci Int. 1980;16:227–29.

    Article  CAS  PubMed  Google Scholar 

  29. Shen WT, Sturgeon C, Duh QY. From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol. 2005;89:186–92.

    Article  PubMed  Google Scholar 

  30. Nakajo M, Onohara S, Shinmura K, Fujiyoshi F, Nakajo M. Embolization for spontaneous retroperitoneal hemorrhage from adrenal myelolipoma. Radiat Med. 2003;21:214–9.

    PubMed  Google Scholar 

  31. Hendrickson RJ, Katzman PJ, Queiroz R, Sitzmann JV, Koniaris LG. Management of massive retroperitoneal hemorrhage from an adrenal tumor. Endocr J. 2001;48:691–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterologic and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

    Luis A. Benavente-Chenhalls MD, David R. Farley MD, Geoffrey B. Thompson MD, Clive S. Grant MD & Melanie L. Richards MD

  2. Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Adrian Vella MD

Authors
  1. Luis A. Benavente-Chenhalls MD
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  2. Adrian Vella MD
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  3. David R. Farley MD
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  4. Geoffrey B. Thompson MD
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  5. Clive S. Grant MD
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  6. Melanie L. Richards MD
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Corresponding author

Correspondence to Melanie L. Richards MD.

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Benavente-Chenhalls, L.A., Vella, A., Farley, D.R. et al. Malignant Adrenal Neoplasm Masquerading as Worrisome Adrenal Hemorrhage. Ann Surg Oncol 17, 2710–2713 (2010). https://doi.org/10.1245/s10434-010-1116-y

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  • DOI: https://doi.org/10.1245/s10434-010-1116-y

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